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Publication Date



These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly, these guidelines should guide care with the understanding that departures from them may be required at times.

Objective of the Care Process Model

The objective of this pathway, besides standardizing care and the benefits associated with care standardization, is to identify and treat diabetic ketoacidosis (DKA) by correcting dehydration and acidosis, reversing ketosis, restoring blood glucose to near normal, avoiding complications of therapy (including cerebral edema), and identifying and treating any precipitating event(s) to prevent future DKA.

Target Users

Emergency Medicine Providers; Pediatric Hospitalists; Endocrinologists; Fellows; Resident Physicians; Pediatric Nursing Practitioners; Staff nurses within Emergency Medicine, Pediatric Critical Care, and Inpatient Services

Clinical Questions Care Process Model

For pediatric patients experiencing diabetic ketoacidosis (DKA) is Lactated Ringer’s (LR) versus Normal Saline (NS) superior in preventing hyperchloremic metabolic acidosis or cerebral edema?

In the pediatric patient with Type I diabetes experiencing diabetic ketoacidosis (DKA) are continuous glucose monitoring (CGM) system results as accurate as fingerstick (i.e., capillary) glucose results?




Care Process Models (CPMs) promote evidence based, safe, and high-value care for patients with common or high-risk clinical conditions when national or international guidelines are not available or applicable. CPMs are informed by methodical review of scientific literature and the consensus of a multidisciplinary committee of subject matter experts and key stakeholders at Children’s Mercy Kansas City. Processes within CPMs may be specific to Children’s Mercy Kansas City and should be evaluated before applying to a different setting.

Care Process Models are updated on a revision schedule. Primary files will always be the most current update. Previous revisions are available upon request from Children’s Mercy Library Services.

Initial April 2013; Revisions: 4/13; 1/14; 9/14; 12/14; 12/15, 12/16;11/19; 07/21; 12/22

Diabetic Ketoacidosis

Included in

Pediatrics Commons



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